The Personal Costs of Medicine

(I wrote this post on a previous blog when I was in a very different state of mind, but I still think it is important to include as it reflects a lot on the pain I was in at that time and where my head was. In this post I mention blame for medical school. The lesson I learned from this was that there is no solution to be found in blaming anything. The end of my relationship was my choice and it resulted in some of the most painful repercussions in my life, but I learned some of the most important lessons of my life too. This is pretty personal post, but I think I will still leave it up.)

I think we discuss a lot of the professional drawbacks to medicine these days, and one of those drawbacks is what medical school has become for many. Between the financial costs and extreme stress I understand why others are finding professions with a total 2-4 year training period a little more attractive. What I am struggling with now though are the personal costs. I feel that I am experiencing the last Cheyne-Stokes respirations of my personal life. Although final exams are past, my board exams, the clerkships and the demands each require are looming before me. Recently, these events have come to affect my decision making in some very painful ways outside of medicine.

Before I go any further, I want to say that there are many well adjusted, happy medical students in my class that seem to have no trouble maintaining balance, a personal life and even extra-curricular activities. I am not sure how they do it, perhaps they are smarter, study less or simply were more balanced people before they entered school. There have even been a few marriages, but also a few divorces. I Have always struggled a bit with personal relationships as well as being a bit OCD, which interferes with the balance of activities and people in my life. Doesn't medical school select people that value perfectionism, O-C traits and that have high expectations of life, others and themselves to some extent? So, perhaps medical school simply is amplifying these traits or else it is generating some new ones, I am not sure.

For the two or three weeks preceding my final exams my relationship with my girlfriend had been feeling strained. It was not just finals but the end of 2nd year overall that seemed to bring it all to a head. When I tried to tell her, and others, about the stresses of medical school I think most everyone outside medicine believes I am talking about the books. The studying is hard, and stressful, but for myself it was not what really seemed to hurt most. What has been killing me for two years is feeling marginalized and continually falling short of the expectations I had of myself and that others (school) have of me. Although I was passing my classes I felt that I was failing every step of the way. Never had I needed to compete at such a high level, with so many capable and intelligent people, and never had I been so completely aware of my own shortcomings, failures, limits and flaws. This is what is hard and stressful.

I had entered school feeling I would be one of the best students around and that my positive outlook and enthusiasm would ensure a stellar course. I had a lot of medical experience and I was a very good EMT and researcher previous to that. I thought this is all I would need to succeed, but I was wrong. I struggled a lot in the classroom. It is not my natural environment. I spent the last two years struggling for grades close to the mean by and large, along with a few really poor outcomes. I expected to at least a standard deviation above the mean, so even though I was passing, I was failing myself.

Near the end of second year the depression really set in. I had no interest in anything, I felt generally anxious all of the time. I either slept too late or not at all. As the end drew nearer I lost the capacity to give to anyone other than myself. I felt as if I was in survival mode. This pattern began to hurt someone I loved very much as she felt herself being pushed aside, forgotten and marginalized in my life. I stopped telling her I loved her, I stopped being physically affectionate in every way possible. It was not about her, it was about the major depression I was in and I fit every major criteria. If I tried to double my efforts and focus on our relationship long enough to salvage it I found schoolwork falling behind and the anxiety over failing a class near the end of the road was overwhelming. Eventually, I made the move to end the relationship but when you only have a single evening a night to talk about these things the process is painfully slow.

Last weekend we had our final discussion. For the last week I expected to feel a sense of relief, happiness even, that my finals were over as I moved into real medicine finally. Instead, I simply feel numb. I do feel some relief of the immediate pressure I was under, but what seems to hang over every action is the sense that I hurt someone I loved me very much and I must say.... I blame medical school.

The last two years taught me much about my limits and I knew I had reached yet another one. It was hard for her to understand, but part of my anxiety and depression was coming from how miserable I was at being a partner to her. I could not take yet another failure in my life. Medical school was pushing me to my limits with my ability to take yet another hit to my ego and I was beginning to hate myself and the person I was becoming. Negative thoughts and anger were my reflexes and I felt everything around me was poisoned. I knew the only way to survive was to slim down everything in my life and focus on only a few things so that I could start succeeding again and feel good about who I was, in and out of school. I asked if we could remain friends, because I felt I could be a good friend, just not a partner. Of course, this was not possible.

Now I am spending some of my new found free time alone as I sit here writing this. I can see studying for the boards and my clerkships (which will keep me out of the city for all but 12 weeks over the next year) as my main priority and I need to start succeeding. I even feel a little hopeful and positive with the sense that I have a chance to wipe my slate and try and approach these next tasks with a clear mind and more positive approach. Still, what hangs over my every thought is the sense that I just stabbed my best friend and love in the back. It makes me feel rather disgusted with myself. I think in the end, we will both be happier on our own paths but that does not take away the pain now.

Trying to start a relationship while in medical school was overly optimistic and with the stress of exams, boards, then clerkships and finally a required move out of state for the residency that I am interested in, it is just too much to try and work in a new relationship. So, Panda's rather monastic and biblically toned post was quite humorous the other day, since lately I feel as if I live in a small stone room denied the pleasures and comforts of the outside world.

I thought I would thrive in medicine....but instead it is strangling me.